Published on in Vol 7 (2024)

Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/54480, first published .
Evaluating Participation in Gender-Affirming Care: Cross-Sectional Analysis of Dermatology Program Websites in the United States

Evaluating Participation in Gender-Affirming Care: Cross-Sectional Analysis of Dermatology Program Websites in the United States

Evaluating Participation in Gender-Affirming Care: Cross-Sectional Analysis of Dermatology Program Websites in the United States

Authors of this article:

Marco Costanza1 Author Orcid Image ;   Jeffrey Sobieraj1 Author Orcid Image ;   Frank Wang1, 2 Author Orcid Image

Research Letter

1University of Michigan Medical School, Ann Arbor, MI, United States

2Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States

Corresponding Author:

Frank Wang, MD

Department of Dermatology

Michigan Medicine

University of Michigan

1500 E Medical Center Drive

Ann Arbor, MI, 48109

United States

Phone: 1 734 936 4054

Email: frawang@med.umich.edu




Transgender and gender-diverse (TGD) patients have unique dermatologic needs, including management of complications from gender-affirming hormone therapy or surgery [1]. Dermatologists play a pivotal role addressing these needs and providing services for gender-affirming care (GAC), such as laser hair removal, management of androgenetic alopecia, injectable neurotoxins, or soft tissue augmentation. To ensure culturally competent care, dermatology residency programs should provide/promote didactic and experiential training tailored to the health needs of TGD patients [2]. Additionally, prospective residents may benefit from being able to ascertain whether certain programs are involved in GAC, including education and research. We aimed to assess the current landscape of GAC participation among dermatology programs and propose strategies to enhance the visibility of such participation.


Using Doximity 2022-2023 Residency Navigator, dermatology residency programs were identified (N=141). From April to July 2023, the websites of each department, residency program, and associated institution were examined to identify participation in GAC. Next, web-based searches were conducted using department and residency program names plus the following terms: “LGBTQ health,” “gender affirming care,” “transgender healthcare,” or “transgender.” Search results were used to identify institutional multidisciplinary GAC programs, volunteer-based services/clinics participating in GAC, and participation in GAC not otherwise mentioned on program websites. Programs were independently reviewed and categorized by authors MC and JS. Interrater reliability was calculated using Cohen κ. Scores ≥0.8 were considered acceptable [3]. For discrepancies in categorization, searches were reconducted with the results discussed to reach a consensus.


Among the 141 examined websites, we found that 22 (15.6%) dermatology programs mentioned providing GAC; the type of participation was variable (Table 1). The remaining programs (n=119, 84.4%) did not mention participating in dermatologic GAC. Of this group, 62 were part of institutions with multidisciplinary GAC programs, while 57 were not. Among the 22 programs participating in GAC, geographic distribution was variable, with the greatest number in the New England region (Figure 1).

Table 1. US dermatology residency programs mentioning involvement in gender-affirming care (GAC).

Programs (N=141), n (%)
Mentioning participation in GAC22 (15.6)

Participation in an institutional multidisciplinary GAC clinica22 (100.0)

Listing a directory of SGMb health providers19 (86.4)

Listing specific gender-affirming dermatologic procedures (eg, electrolysis or neurotoxins)12 (54.5)

Listing GAC under a “services offered” tab6 (27.3)

GAC program led by dermatology department3 (13.6)
Not mentioning participation inGAC119 (84.4)

Multidisciplinary GAC clinic at institution but no mention of dermatology involvement62 (52.1)

No mention of gender-affirming care on institutional website57 (47.9)

aParticipation in a multidisciplinary clinic was defined as at least one faculty member representing the department in the clinic.

bSGM: sexual and gender minority.

Figure 1. Geographic distribution of dermatology programs participating in gender-affirming care. The choropleth map shows the proportion of programs involved in gender-affirming care (GAC) per geographic region, as defined by the Association of American Medical Colleges. The number of programs with GAC out of total programs in the region are displayed, along with associated percentages and color according to the scale.

We found that a minority of dermatology programs mentioned participating in GAC, indicating that there remains a considerable gap between the desired and current state of resident education in gender minority health [4,5]. Indeed, dermatology residents receive, on average, 75 minutes of sexual and gender minority (SGM) health education yearly [5] and report low competency and confidence in caring for TGD patients [5,6]. Furthermore, dermatology program directors report barriers to implementing SGM health training, such as lack of funding, curricular time, and experienced faculty [4].

We observed that over 60 dermatology programs did not mention participating in GAC but are affiliated with institutions with multidisciplinary GAC clinics. These programs may consider collaborating with providers in those clinics to improve resident education and care of TGD patients. Highlighting such collaborations may aid recruitment of SGM-identifying residency/faculty candidates, especially those interested in teaching or studying SGM dermatology.

Furthermore, it is possible that some programs actually participate in GAC but do not “advertise” it on websites. Importantly, scrutiny or legal repercussions may affect the visibility or availability of GAC services of some programs, particularly those affiliated with pediatric hospitals. Thus, when permissible, programs can implement simple measures to highlight their efforts. Program websites could identify departmental or institutional providers passionate about providing GAC. Programs may provide information on whether they perform minimally invasive procedures for GAC, like laser hair removal, injectable neurotoxins, or soft tissue augmentation. Likewise, displaying images of providers wearing pronoun badges or “pride pins” may foster an inclusive environment for patients and providers [7]. These measures do not require curricular time or funding and are associated with improved health outcomes [1,7].

Overall, our results expand upon those of a recent study, specifically by indicating how dermatology programs participate in GAC beyond involvement in multidisciplinary clinics [8]. Our study’s limitations include using publicly available websites, which may not fully reflect TGD health content within curricula, collaborations with GAC experts, or dermatology research related to TGD patients. Future research can address these limitations by surveying program directors or multidisciplinary GAC clinics to ascertain the specifics of departmental involvement.

Our study provides insights into the various types of participation in GAC among dermatology residency programs, as well as existing challenges program directors face and potential clinical and nonclinical opportunities for improvement. Program websites may serve as a valuable and accessible resource to help TGD patients obtain GAC and to attract diverse residency and faculty candidates to a program. To cultivate a safe environment for patients and providers alike, program directors could consider, when possible/permissible, relatively easy yet impactful ways to use their program/departmental websites to enhance and advertise their participation in GAC.

Conflicts of Interest

None declared.

  1. Yeung H, Luk KM, Chen SC, Ginsberg BA, Katz KA. Dermatologic care for lesbian, gay, bisexual, and transgender persons: terminology, demographics, health disparities, and approaches to care. J Am Acad Dermatol. Mar 2019;80(3):581-589. [FREE Full text] [CrossRef] [Medline]
  2. Sternhell-Blackwell K, Mansh M, Peebles JK. Residency education on sexual and gender minority health: ensuring culturally competent dermatologists and excellent patient care. JAMA Dermatol. May 01, 2020;156(5):497-499. [CrossRef] [Medline]
  3. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22(3):276-282. [FREE Full text] [Medline]
  4. Jia JL, Nord KM, Sarin KY, Linos E, Bailey EE. Sexual and gender minority curricula within US dermatology residency programs. JAMA Dermatol. May 01, 2020;156(5):593-594. [FREE Full text] [CrossRef] [Medline]
  5. Nowaskie D, Garcia-Dehbozorgi S, Cortez J. The current state of lesbian, gay, bisexual, and transgender cultural competency among U.S. dermatology residents. Int J Womens Dermatol. Oct 2022;8(3):e030. [FREE Full text] [CrossRef] [Medline]
  6. Vengalil N, Shumer D, Wang F. Developing an LGBT curriculum and evaluating its impact on dermatology residents. Int J Dermatology. Aug 20, 2021;61(1):99-102. [CrossRef] [Medline]
  7. Hudson KD, Bruce-Miller V. Nonclinical best practices for creating LGBTQ-inclusive care environments: a scoping review of gray literature. J Gay Lesbian Soc Services. Apr 04, 2022;35(2):218-240. [CrossRef]
  8. Reddy SA, Fisher C, Mansh MD, Peebles JK. Dermatology representation in academic clinical gender care programs in the United States: a cross-sectional study. J Am Acad Dermatol. Nov 03, 2023:S0190-9622(23)03111-0. [CrossRef] [Medline]


GAC: gender-affirming care
SGM: sexual and gender minority
TGD: transgender and gender-diverse


Edited by R Dellavalle, CC Chi; submitted 10.11.23; peer-reviewed by H Yeung, OP Hamnvik; comments to author 17.12.23; revised version received 24.01.24; accepted 25.01.24; published 12.02.24.

Copyright

©Marco Costanza, Jeffrey Sobieraj, Frank Wang. Originally published in JMIR Dermatology (http://derma.jmir.org), 12.02.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Dermatology, is properly cited. The complete bibliographic information, a link to the original publication on http://derma.jmir.org, as well as this copyright and license information must be included.